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Alidina S, Menon G, Staffa SJ, Alreja S, Barash D, Barringer E, Cainer M, Citron I, DiMeo A, Ernest E, Fitzgerald L, Ghandour H, Gruendl M, Hellar A, Jumbam DT, Katoto A, Kelly L, Kisakye S, Kuchukhidze S, Lama T, Lodge Ii W, Maina E, Massaga F, Mazhiqi A, Meara JG, Mshana S, Nason I, Reynolds C, Reynolds C, Segirinya H, Simba D, Smith V, Strader C, Sydlowski M, Tibyehabwa L, Tinuga F, Troxel A, Ulisubisya M, Varallo J, Wurdeman T, Zanial N, Zurakowski D, Kapologwe N, Maongezi S. Outcomes of a multicomponent safe surgery intervention in Tanzania's Lake Zone: a prospective, longitudinal study. Int J Qual Health Care 2021; 33:6289905. [PMID: 34057187 PMCID: PMC8240014 DOI: 10.1093/intqhc/mzab087] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/12/2021] [Accepted: 05/30/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Evidence-based strategies for improving surgical quality and patient outcomes in low-resource settings are a priority. OBJECTIVE To evaluate the impact of a multicomponent safe surgery intervention (Safe Surgery 2020) on (1) adherence to safety practices, teamwork and communication, and documentation in patient files, and (2) incidence of maternal sepsis, postoperative sepsis, and surgical site infection. METHODS We conducted a prospective, longitudinal study in 10 intervention and 10 control facilities in Tanzania's Lake Zone, across a 3-month pre-intervention period in 2018 and 3-month post-intervention period in 2019. SS2020 is a multicomponent intervention to support four surgical quality areas: (i) leadership and teamwork, (ii) evidence-based surgery, anesthesia and equipment sterilization practices, (iii) data completeness and (iv) infrastructure. Surgical team members received training and mentorship, and each facility received up to a $10 000 infrastructure grant. Inpatients undergoing major surgery and postpartum women were followed during their stay up to 30 days. We assessed adherence to 14 safety and teamwork and communication measures through direct observation in the operating room. We identified maternal sepsis (vaginal or cesarean delivery), postoperative sepsis and SSIs prospectively through daily surveillance and assessed medical record completeness retrospectively through chart review. We compared changes in surgical quality outcomes between intervention and control facilities using difference-in-differences analyses to determine areas of impact. RESULTS Safety practices improved significantly by an additional 20.5% (95% confidence interval (CI), 7.2-33.7%; P = 0.003) and teamwork and communication conversations by 33.3% (95% CI, 5.7-60.8%; P = 0.02) in intervention facilities compared to control facilities. Maternal sepsis rates reduced significantly by 1% (95% CI, 0.1-1.9%; P = 0.02). Documentation completeness improved by 41.8% (95% CI, 27.4-56.1%; P < 0.001) for sepsis and 22.3% (95% CI, 4.7-39.8%; P = 0.01) for SSIs. CONCLUSION Our findings demonstrate the benefit of the SS2020 approach. Improvement was observed in adherence to safety practices, teamwork and communication, and data quality, and there was a reduction in maternal sepsis rates. Our results support the emerging evidence that improving surgical quality in a low-resource setting requires a focus on the surgical system and culture. Investigation in diverse contexts is necessary to confirm and generalize our results and to understand how to adapt the intervention for different settings. Further work is also necessary to assess the long-term effect and sustainability of such interventions.
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Affiliation(s)
- Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Gopal Menon
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02215, USA
| | - Sakshie Alreja
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - David Barash
- GE Foundation, 5 Necco Street, Boston, MA 02210, USA
| | - Erin Barringer
- Dalberg Implement-Dalberg, Indian Ocean Building, Block C, 4th Floor, 383 Toure Drive, Dar es Salaam, Tanzania
| | - Monica Cainer
- Assist International, 800 South Stockton Avenue, Ripon, CA 95366, USA
| | - Isabelle Citron
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Amanda DiMeo
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Edwin Ernest
- Safe Surgery 2020 Project, Plot No. 72, Block 45 B Victoria Area, New Bagamoyo Road, Jhpiego, Dar es Salaam, Tanzania
| | - Laura Fitzgerald
- Safe Surgery 2020 Project, Plot No. 72, Block 45 B Victoria Area, New Bagamoyo Road, Jhpiego, Dar es Salaam, Tanzania
| | - Hiba Ghandour
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Magdalena Gruendl
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Audustino Hellar
- Safe Surgery 2020 Project, Plot No. 72, Block 45 B Victoria Area, New Bagamoyo Road, Jhpiego, Dar es Salaam, Tanzania
| | - Desmond T Jumbam
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Adam Katoto
- Safe Surgery 2020 Project, Plot No. 72, Block 45 B Victoria Area, New Bagamoyo Road, Jhpiego, Dar es Salaam, Tanzania
| | - Lauren Kelly
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Steve Kisakye
- Dalberg Implement-Dalberg, Indian Ocean Building, Block C, 4th Floor, 383 Toure Drive, Dar es Salaam, Tanzania
| | - Salome Kuchukhidze
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Tenzing Lama
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - William Lodge Ii
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Erastus Maina
- Dalberg Implement-Dalberg, Indian Ocean Building, Block C, 4th Floor, 383 Toure Drive, Dar es Salaam, Tanzania
| | - Fabian Massaga
- Department of Surgery, Bugando Medical Center, Block Z, Plot 229 Wurzbarg Road, Mwanza, Tanzania
| | - Adelina Mazhiqi
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02215, USA
| | - Stella Mshana
- Safe Surgery 2020 Project, Plot No. 72, Block 45 B Victoria Area, New Bagamoyo Road, Jhpiego, Dar es Salaam, Tanzania
| | - Ian Nason
- Department of Health Policy and Management, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
| | - Chase Reynolds
- Assist International, 800 South Stockton Avenue, Ripon, CA 95366, USA
| | - Cheri Reynolds
- Assist International, 800 South Stockton Avenue, Ripon, CA 95366, USA
| | | | - Dorcas Simba
- Safe Surgery 2020 Project, Plot No. 72, Block 45 B Victoria Area, New Bagamoyo Road, Jhpiego, Dar es Salaam, Tanzania
| | - Victoria Smith
- Assist International, 800 South Stockton Avenue, Ripon, CA 95366, USA
| | - Christopher Strader
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Meaghan Sydlowski
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Leopold Tibyehabwa
- Safe Surgery 2020 Project, Plot No. 72, Block 45 B Victoria Area, New Bagamoyo Road, Jhpiego, Dar es Salaam, Tanzania
| | - Florian Tinuga
- Department of Health, Social Welfare and Nutrition Service, President's Office-Regional Administration and Local Government, Tamisemi Street, Government City-Mtumba, Dodoma, Tanzania
| | - Alena Troxel
- Safe Surgery 2020 Project, Plot No. 72, Block 45 B Victoria Area, New Bagamoyo Road, Jhpiego, Dar es Salaam, Tanzania
| | - Mpoki Ulisubisya
- Department of Curative Services, Ministry of Health, Community Development, Gender, Elderly and Children, Government City-Mtumba, Dodoma, Tanzania
| | - John Varallo
- Safe Surgery 2020 Project, Plot No. 72, Block 45 B Victoria Area, New Bagamoyo Road, Jhpiego, Dar es Salaam, Tanzania
| | - Taylor Wurdeman
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Noor Zanial
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02215, USA
| | - Ntuli Kapologwe
- Department of Health, Social Welfare and Nutrition Service, President's Office-Regional Administration and Local Government, Tamisemi Street, Government City-Mtumba, Dodoma, Tanzania
| | - Sarah Maongezi
- Department of Curative Services, Ministry of Health, Community Development, Gender, Elderly and Children, Government City-Mtumba, Dodoma, Tanzania
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2
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Sprow HN, Hansen NF, Loeb HE, Wight CL, Patterson RH, Vervoort D, Kim EE, Greving R, Mazhiqi A, Wall K, Corley J, Anderson E, Chu K. Gender-Based Microaggressions in Surgery: A Scoping Review of the Global Literature. World J Surg 2021; 45:1409-1422. [PMID: 33575827 DOI: 10.1007/s00268-021-05974-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In addition to systemic gender disparities, women in surgery encounter interpersonal microaggressions. The objective of this study is to describe the most common forms of microaggressions reported by women in surgery. METHODS We conducted a scoping review using PubMed/MEDLINE, Ovid, and Web of Science to describe the international, indexed English-language literature on gender-based microaggressions experienced by female surgeons, surgical trainees, and medical students in surgery. After screening by title, abstract, and full-text, 37 articles were retained for data extraction and analysis. Microaggressions were analyzed using the Sexist Microaggression Experience and Stress Scale (MESS) framework and stratified by country of origin. RESULTS Gender-based microaggression publications most commonly originated from the United States (n = 27 articles), Canada (n = 3), and India (n = 2). Gender-based microaggressions were classified into environmental invalidations (n = 20), being treated like a second-class citizen (n = 18), assumptions of traditional gender roles (n = 12), sexual objectification (n = 11), assumptions of inferiority (n = 10), being forced to leave gender at the door (n = 8), and experiencing sexist language (n = 6). Additionally, attendings were more frequently reported to experience microaggressions than surgical trainees and medical students, but more articles reported data on attendings (n = 16) than surgical trainees (n = 10) or students (n = 4). CONCLUSION While recent advancements have opened the field of surgery to women, there is still a lack of female representation, and persistent microaggressions may perpetuate this gender disparity. Addressing microaggressions against female surgeons is essential to achieving gender equity in surgical practice.
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Affiliation(s)
- Holly N Sprow
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, USA.
- Gender Equity Initiative in Global Surgery, 641 Huntington Avenue, Boston, MA, USA.
- , 365 Washington St, Brighton, MA, 02135, USA.
| | - Nathaniel F Hansen
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, USA
- Gender Equity Initiative in Global Surgery, 641 Huntington Avenue, Boston, MA, USA
| | - Hannah E Loeb
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, USA
- Gender Equity Initiative in Global Surgery, 641 Huntington Avenue, Boston, MA, USA
| | - Caroline L Wight
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, USA
- Gender Equity Initiative in Global Surgery, 641 Huntington Avenue, Boston, MA, USA
| | - Rolvix H Patterson
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, USA
- Gender Equity Initiative in Global Surgery, 641 Huntington Avenue, Boston, MA, USA
| | - Dominique Vervoort
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, USA
- Gender Equity Initiative in Global Surgery, 641 Huntington Avenue, Boston, MA, USA
| | - Eliana E Kim
- University of California-San Francisco School of Medicine, 533 Parnassus Ave, San Francisco, CA, USA
- Gender Equity Initiative in Global Surgery, 641 Huntington Avenue, Boston, MA, USA
| | - Raphael Greving
- Gießen School of Medicine, Justus-Liebig-University, Ludwigstraße 23, 35390, Gießen, Germany
- Gender Equity Initiative in Global Surgery, 641 Huntington Avenue, Boston, MA, USA
| | - Adelina Mazhiqi
- Ängelholm Hospital, Landshövdingevägen 7E, 262 52, Ängelholm, Sweden
- Gender Equity Initiative in Global Surgery, 641 Huntington Avenue, Boston, MA, USA
| | - Kathryn Wall
- Gender Equity Initiative in Global Surgery, 641 Huntington Avenue, Boston, MA, USA
| | - Jacquelyn Corley
- Department of Neurosurgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, USA
- Gender Equity Initiative in Global Surgery, 641 Huntington Avenue, Boston, MA, USA
| | - Emily Anderson
- Gender Equity Initiative in Global Surgery, 641 Huntington Avenue, Boston, MA, USA
- Department of Neurosurgery, Tufts Medical Center, 800 Washington Street, Boston, MA, USA
| | - Kathryn Chu
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Tygerberg, 7505, South Africa
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3
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Alidina S, Chatterjee P, Zanial N, Alreja SS, Balira R, Barash D, Ernest E, Giiti GC, Maina E, Mazhiqi A, Mushi R, Reynolds C, Sydlowski M, Tinuga F, Maongezi S, Meara JG, Kapologwe NA, Barringer E, Cainer M, Citron I, DiMeo A, Fitzgerald L, Ghandour H, Gruendl M, Hellar A, Jumbam DT, Katoto A, Kelly L, Kisakye S, Kuchukhidze S, Lama TN, Menon G, Mshana S, Reynolds C, Segirinya H, Simba D, Smith V, Staffa SJ, Strader C, Tibyehabwa L, Troxel A, Varallo J, Wurdeman T, Zurakowski D. Improving surgical quality in low-income and middle-income countries: why do some health facilities perform better than others? BMJ Qual Saf 2021; 30:937-949. [PMID: 33547219 PMCID: PMC8606467 DOI: 10.1136/bmjqs-2020-011795] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/15/2020] [Accepted: 01/18/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Evidence on heterogeneity in outcomes of surgical quality interventions in low-income and middle-income countries is limited. We explored factors driving performance in the Safe Surgery 2020 intervention in Tanzania's Lake Zone to distil implementation lessons for low-resource settings. METHODS We identified higher (n=3) and lower (n=3) performers from quantitative data on improvement from 14 safety and teamwork and communication indicators at 0 and 12 months from 10 intervention facilities, using a positive deviance framework. From 72 key informant interviews with surgical providers across facilities at 1, 6 and 12 months, we used a grounded theory approach to identify practices of higher and lower performers. RESULTS Performance experiences of higher and lower performers differed on the following themes: (1) preintervention context, (2) engagement with Safe Surgery 2020 interventions, (3) teamwork and communication orientation, (4) collective learning orientation, (5) role of leadership, and (6) perceived impact of Safe Surgery 2020 and beyond. Higher performers had a culture of teamwork which helped them capitalise on Safe Surgery 2020 to improve surgical ecosystems holistically on safety practices, teamwork and communication. Lower performers prioritised overhauling safety practices and began considering organisational cultural changes much later. Thus, while also improving, lower performers prioritised different goals and trailed higher performers on the change continuum. CONCLUSION Future interventions should be tailored to facility context and invest in strengthening teamwork, communication and collective learning and facilitate leadership engagement to build a receptive climate for successful implementation of safe surgery interventions.
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Affiliation(s)
- Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Pritha Chatterjee
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Noor Zanial
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Sakshie Sanjay Alreja
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Rebecca Balira
- Department of Epidemiology, National Institute for Medical Research Mwanza Research Centre, Mwanza, Tanzania
| | | | - Edwin Ernest
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania
| | | | | | - Adelina Mazhiqi
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Rahma Mushi
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Cheri Reynolds
- Department of Global Health, Assist International, Ripon, California, USA
| | - Meaghan Sydlowski
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Florian Tinuga
- Department of Health, Social Welfare and Nutrition Service, President's Office - Regional Administration and Local Government, Dodoma, Tanzania
| | - Sarah Maongezi
- Department of Adult Non-Communicable Diseases, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ntuli A Kapologwe
- Department of Health, Social Welfare and Nutrition Service, President's Office - Regional Administration and Local Government, Dodoma, Tanzania
| | - Erin Barringer
- Dalberg Advisors, Dalberg Group, New York, New York, USA
| | - Monica Cainer
- Department of Global Health, Assist International, Ripon, California, USA
| | - Isabelle Citron
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Amanda DiMeo
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | | | - Hiba Ghandour
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Magdalena Gruendl
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | | | - Desmond T Jumbam
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Adam Katoto
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania
| | - Lauren Kelly
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Steve Kisakye
- Dalberg Implement, Dalberg Group, Dar es Salaam, Tanzania
| | - Salome Kuchukhidze
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Tenzing N Lama
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Gopal Menon
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Stella Mshana
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania
| | - Chase Reynolds
- Department of Global Health, Assist International, Ripon, California, USA
| | | | - Dorcas Simba
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania
| | - Victoria Smith
- Department of Global Health, Assist International, Ripon, California, USA
| | - Steven J Staffa
- Departments of Anesthesiology and Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christopher Strader
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | | | - Alena Troxel
- Safe Surgery 2020 Project, Jhpiego, Baltimore, Maryland, USA
| | - John Varallo
- Safe Surgery 2020 Project, Jhpiego, Baltimore, Maryland, USA
| | - Taylor Wurdeman
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - David Zurakowski
- Departments of Anesthesiology and Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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4
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Wurdeman T, Strader C, Alidina S, Barash D, Citron I, Kapologwe N, Maina E, Massaga F, Mazhiqi A, Meara JG, Menon G, Reynolds C, Sydlowski M, Varallo J, Maongezi S, Ulisubisya M. In-Hospital Postoperative Mortality Rates for Selected Procedures in Tanzania's Lake Zone. World J Surg 2020; 45:41-49. [PMID: 32995932 PMCID: PMC7752880 DOI: 10.1007/s00268-020-05802-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2020] [Indexed: 01/22/2023]
Abstract
Background Postoperative mortality rate is one of six surgical indicators identified by the Lancet Commission on Global Surgery for monitoring access to high-quality surgical care. The primary aim of this study was to measure the postoperative mortality rate in Tanzania’s Lake Zone to provide a baseline for surgical strengthening efforts. The secondary aim was to measure the effect of Safe Surgery 2020, a multi-component intervention to improve surgical quality, on postoperative mortality after 10 months. Methods We prospectively collected data on postoperative mortality from 20 health centers, district hospitals, and regional hospitals in Tanzania’s Lake Zone over two time periods: pre-intervention (February to April 2018) and post-intervention (March to May 2019). We analyzed postoperative mortality rates by procedure type. We used logistic regression to determine the impact of Safe Surgery 2020 on postoperative mortality. Results The overall average in-hospital non-obstetric postoperative mortality rate for all surgery procedures was 2.62%. The postoperative mortality rates for laparotomy were 3.92% and for cesarean delivery was 0.24%. Logistic regression demonstrated no difference in the postoperative mortality rate after the Safe Surgery 2020 intervention. Conclusions Our results inform national surgical planning in Tanzania by providing a sub-national baseline estimate of postoperative mortality rates for multiple surgical procedures and serve as a basis from which to measure the impact of future surgical quality interventions. Our study showed no improvement in postoperative mortality after implementation of Safe Surgery 2020, possibly due to low power to detect change. Electronic supplementary material The online version of this article (10.1007/s00268-020-05802-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Taylor Wurdeman
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Christopher Strader
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Surgery, University of Massachusetts, Worcester, MA, USA
| | - Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | | | - Isabelle Citron
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Ntuli Kapologwe
- Department of Health, Social Welfare and Nutrition Service, President's Office - Regional Administration and Local Government, Dodoma, Tanzania
| | | | - Fabian Massaga
- Bugando Medical Centre, Consultant and Teaching University Hospital, Mwanza, Tanzania
| | - Adelina Mazhiqi
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Internal Medicine, Ängelholm Hospital, Ängelholm, Sweden
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Gopal Menon
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | | | - Meaghan Sydlowski
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | | | - Sarah Maongezi
- Ministry of Health, Community Development, Gender, Elderly & Children, Dodoma, Tanzania
| | - Mpoki Ulisubisya
- Ministry of Health, Community Development, Gender, Elderly & Children, Dodoma, Tanzania
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5
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Truché P, Shoman H, Reddy CL, Jumbam DT, Ashby J, Mazhiqi A, Wurdeman T, Ameh EA, Smith M, Lugazia E, Makasa E, Park KB, Meara JG. Globalization of national surgical, obstetric and anesthesia plans: the critical link between health policy and action in global surgery. Global Health 2020; 16:1. [PMID: 31898532 PMCID: PMC6941290 DOI: 10.1186/s12992-019-0531-5] [Citation(s) in RCA: 191] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/13/2019] [Indexed: 11/17/2022] Open
Abstract
Efforts from the developed world to improve surgical, anesthesia and obstetric care in low- and middle-income countries have evolved from a primarily volunteer mission trip model to a sustainable health system strengthening approach as private and public stakeholders recognize the enormous health toll and financial burden of surgical disease. The National Surgical, Obstetric and Anesthesia Plan (NSOAP) has been developed as a policy strategy for countries to address, in part, the health burden of diseases amenable to surgical care, but these plans have not developed in isolation. The NSOAP has become a phenomenon of globalization as a broad range of partners - individuals and institutions - help in both NSOAP formulation, implementation and financing. As the nexus between policy and action in the field of global surgery, the NSOAP reflects a special commitment by state actors to make progress on global goals such as Universal Health Coverage and the United Nations Sustainable Development Goals. This requires a continued global commitment involving genuine partnerships that embrace the collective strengths of both national and global actors to deliver sustained, safe and affordable high-quality surgical care for all poor, rural and marginalized people.
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Affiliation(s)
- Paul Truché
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Haitham Shoman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Ché L. Reddy
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Desmond T. Jumbam
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA USA
| | - Joanna Ashby
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Adelina Mazhiqi
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Taylor Wurdeman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | | | - Martin Smith
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Edwin Lugazia
- Department of Anaesthesiology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Emmanuel Makasa
- PSMD-Cabinet Office, Office of the President, Lusaka, Zambia
- Wits Centre of Surgical Care for Primary Health and Sustainable Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Kee B. Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - John G. Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA USA
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